The experts got it wrong on face masks

This is why it’s important to challenge government guidance.

Matthew Lesh

At every turn in the coronavirus crisis, we have been told by stern ministers standing at the No10 lecterns that their actions are guided by ‘the science’.

This is a questionable claim at the best of times – there is no such thing as ‘the science’ in the singular. Science, particularly in public health, is heavily contested. It is the point of science to be testable and contestable. Ministers are trying to follow the best evidence, but should not exaggerate certainty.

In one area, however, Public Health England’s advice is dramatically opposed to the bulk of global scientific evidence: masks.

From early on, the general public have been advised by the World Health Organisation against wearing masks, on the basis that they provide limited protection. This has been echoed in the UK. In January, a PHE blog about Covid-19 advised that there is ‘very little evidence of widespread benefit from [mask] use outside of these clinical settings’. They have not changed tune on this topic.

Nevertheless, we are told every day about the lack of personal protective equipment (PPE) needed in hospitals to save lives. This, of course, includes masks. Somehow equipment that is essential for healthcare workers won’t help the rest of us.

Both claims can’t be simultaneously true – and they’re not.

Reviews of the evidence have concluded that ‘any physical barrier, as provided even by makeshift masks, may substantially reduce the spread of Covid-19’. A review of 46 scientific papers, including various meta-analyses, found that masks can be effective in reducing virus transmission. Not a single paper suggests the opposite. When the dust settles we’ll see that masks, along with testing, are an area where health authorities have made dramatic mistakes.

This all goes back to the high-speed projectile droplets that spray from an infected person’s mouth who unknowingly – even among asymptomatic patients or those with mild symptoms – causes transmission. A recent MIT study concluded that liquid droplets from coughs could reach as far as six metres away, and sneezes eight metres.

Masks, particularly the sophisticated N95 type, can filter out the smallest particles. Larger droplets, however, can be stopped by any physical barrier. This can help prevent you from getting the virus. (It’s not foolproof: you do have to carefully dispose of the masks to avoid contamination, change the mask frequently, and still regularly wash your hands.)

But perhaps even more importantly, masks help prevent people with the virus from spraying those droplets in the first place. The aforementioned MIT study concluded that masks ‘should have the ability to repeatedly withstand the kind of high-momentum multiphase turbulent gas cloud that may be ejected during a sneeze or a cough and the exposure from them’.

Covid-19 is threatening because of two essential features: a large amount of time in which people who are asymptomatic or have mild symptoms can give it to others, and a relatively high death rate.

The precise reason we need a strong mask-wearing culture in this crisis is that anybody could have it and spread it without realising. Wearing a mask would stop individuals without the tell-tale signs or those with mild symptoms from unintentionally spraying those deadly droplets.

It’s not even true that the only mask that would help would be an N95-style mask with a respirator. A recent review by the Oxford Covid-19 Evidence Service concluded that there’s relatively little between respirator marks and standard surgical face masks. While respirator masks are ideal – and necessary in hot spots like intensive-care wards – surgical masks could provide substantial protection for the general public.

There’s even evidence that homemade masks (for example, from old t-shirts or scarves, as long as they’re removed carefully and laundered afterwards) could stop those inward deadly aerosols.

Every day new studies on the potential for masks are emerging. Just in the past few days reports have emerged that the WHO is reconsidering its advice after a study from Hong Kong found that masks could be effective in protecting individuals from infection. On Friday, President Trump announced that the Centers for Disease Control (CDC) will begin recommending people wear cloth masks to tackle Covid-19, reserving surgical or N95 masks for medical professionals.

Worryingly, previous advice has stigmatised mask-wearing – unlike in Asian countries such as South Korea, Hong Kong and Singapore. It is no coincidence that these mask-wearing countries are the ones that have got infection and death rates down. Masks are another tool in our arsenal to help flatten the curve. They could be hugely valuable. According to one calculation, if masks reduce transmission possibilities by just 10 per cent – and it could be as much as a 40 per cent to 50 per cent reduction – then each cloth mask would be worth US$3,000 and US$6,000 in benefit.

The current advice appears to be driven by the notion that the surge in mask-buying by the general public would cause shortages of essential equipment for healthcare professionals. But this reflects a limited grasp of the dynamism of economic systems.

First, there are already shortages. That ship has sailed. Secondly, even stronger demand and more shortages – and even temporarily higher prices – would encourage producers to manufacture the billions of masks that the world now needs. We should be providing a strong market incentive for every factory that can to repurpose their machinery for masks. We should not assume that shortages last forever.

There is also an assumption that people will wear them incorrectly or not change them frequently enough, rendering them useless. This puts the perfect above the good. Just because some people may misuse them doesn’t remove the potential benefit from many using them correctly.

In any case, we shouldn’t arrogantly assume people are too dumb to learn how to properly use masks. They’re not that difficult a technology. We just need to explain it.

In recent years we have been told again and again that we must rely faithfully on ‘experts’, or risk falling to the populist disease. This has always been an anti-intellectual assertion. Experts are human. They, too, can make the wrong assumptions, misread evidence and give bad advice. We should listen to experts, but we should question them, too. They need the scrutiny.

The experts have gotten it wrong when it comes to masks. A good expert changes their mind, and their advice, when new evidence emerges.

Matthew Lesh is head of research at the Adam Smith Institute.

Picture by: Getty.

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Comments

Johnny Hunter

8th April 2020 at 9:12 pm

Please sign this petition to the UK government. This is our chance to make something happen! #masks4all #masks4alluk

“Make it mandatory to wear a face mask in public during Covid-19 Pandemic”
https://petition.parliament.uk/petitions/304397

Catharine Knowles

6th April 2020 at 10:08 pm

Before the lock down, I had a chat with some women from Hong Kong who were wearing masks. They told me that as soon as the Hong Kong government heard about Covid19, they made sure they had plenty of masks for the whole population. That part of the world is used to these pandemics, and wearing masks is part of their culture. They asked me why we weren’t wearing masks in the UK. I explained that government scientists had told us that they don’t stop you catching Covid-19. They explained that they did not wear them to stop catching diseases, but, out of courtesy for others, to try to stop spreading them. For some reason this had not entered my head: I assumed they were worried about catching things. I now think maybe we should all wear masks if we have a cough or cold: perhaps the number of flu-related deaths would reduce. Even if they reduced the number of coughs and colds it would be a good thing.

One of the first measures Japan took, too, was to insist that it’s entire population wore masks.

Lyn Keay

7th April 2020 at 11:15 am

They are useful for catching coughs & sneezes where people are used to using them. It’s important to not touch the front of the mask even when taking them off. Our governments advice to cough & sneeze into a tissue / elbow works just as well though. Especially if you wash your hands afterwards.

carlos griffin

6th April 2020 at 8:44 pm

Euphemisms used by the Mint/Mind Governors:

Science = Our propagandists who have constructed a load of balloney just so you don’t cotton on that we’re not actually qualified or know what we’re talking about and you knowing hte truth threatens our power to manipulate you.

National Interest = Our Private Profits

Rules or Laws = Petty Lies we made up to control you into giving us your money and accepting the abuse we mete upon you. All of which is a lie because you havent signed a contract agreeing to be controlled by those laws because ultimately you are a free being with every right to a decent standard of life but we’re gonna pretend that you’re an evolved ape in order to confuse you and make you believe that we’re the alphas when in truth if we were put in a room with you you could tear us limb from limb in an instant because we’re a bunch of accountants and lawyers and journos who really have no business being the moral arbiters of a chat room let alone a whole country of people.

Now for some truth:
Electro Magnetic Fields induce a current in all electrical systems within range. Your body is wholly an electrical system in a careful state of balance. WIFI And RADIO WILL AND DOES AND HAS BEEN PROVEN SCIENTIFICALLY TO MAKE YOU SICK. Anyone who claims that 5G is perfectly healthy is Lying to save their own arse!

Negative emotions such as anger make the body acidic.

Acidity is a negative electric charge!
Sickness is caused by an excess of negativity.

You cannot and should not ever trust a “government minister”. They are the enemies of truth.
They are not your friends. They are your slavers who try their best to keep you in a slightly negative and confused state and pretend to have all the answers. They don’t have the answers. They’re not wizards or polymaths or students of Sacred Geometry. They’re corporate investors looking to maintain their corporate interests.

Break the cycle of fear and you’ll find you’re a little bit more Super than that “society/cult” would like you to believe!

Positive and Negative, Happy Face and Angry face. These are the Twin powers of the universe of which all is constructed. And the keys of all esoteric mystery schools.

Darth Saddius

7th April 2020 at 11:21 am

With regard to acidity your post is incorrect. Acidity is (simplifying somewhat) a measure of the concentration of hydrogen ions in an aqueous system. These ions are positively charged, not negatively charged.

With regard to your frankly novel theories concerning 5G radiation if you are worried than I would suggest wearing headgear made from the element with atomic number 13.

Tim Wheeler

6th April 2020 at 7:53 pm

“We have been told by stern ministers standing at the No10 lecterns that their actions are guided by ‘the science’.” Words (particularly politicians’ words) are a moveable feast. Could it not have been the ‘science’ of mass psychology that was guiding them? If the real aim was to panic buying of masks then “guided by science” would in a sense be true.

Tim Wheeler

6th April 2020 at 8:04 pm

Okay – I omitted the work ‘prevent’ in the above LOL.

Jim Lawrie

6th April 2020 at 7:11 pm

I’ve seen people take their mask off to sneeze.

James Knight

6th April 2020 at 6:21 pm

Why is the article full of references to studies and literature? Why is it with masks we suddenly need that? Where is the demand for evidence and data that nuking the economy is effective? We know how viruses spread, it is common sense. Masks are cheap, trashing the economy is expensive. Bangladesh just lost £2.4billion in garment orders. 10million extra unemployed in the US, 1 million extra unemployed in the UK. Figures that dwarf the 2008 recession. China is predicting 0% GDP growth. But this economic inferno and the human consequences is not part of any “model” or calculation in any scientific paper. It counts for zero to “experts”.

The experts rubbishing the public wearing masks are slimeballs. They are trying to cover up for the fact they don’t have the PPE for health care staff because they didn’t have a proper contingency plan. They don’t want the public buying up all the masks. The real covidiots are Public Health England and NHS managers. When we have finished counting the dead, we will need the civilian equivalent of a war crimes tribunal to bring them to account.

Lyn Keay

6th April 2020 at 5:59 pm

A potentially good article is spoiled by so much misunderstanding that I almost don’t know where to start. We should definitely question experts, especially when they are being asked to speak beyond their competence. I find it deeply frustrating that while the UK government publish most of the base data they are using, they don’t publish the decision making that flows from it. Reading between the lines of what the marvelous Dr Jenny Harries says in a press briefing is prone to error, but the best we can do. And the we’re doing everything at exactly the right time line is wearing incredibly think.

On masks, however, this article is severely flawed.

Firstly, it fails to take into account that wearing a mask incorrectly can lead to an INCREASED risk of infection. If you do touch it then you potentially put virus all over your hands and spread it around surfaces, which are a much bigger source of infection that breathing. ‘We’ may well be able to explain how to fit a mask, but despite suggesting how this would be done, yet despite all its advice on how to to this, this article fails to mention the critical step of not touching the front of the mask when removing it. So, at least one intelligent man (the author) hasn’t worked out how to do this, giving some credence to the medical professionals caution in recommending the use of masks. If you want to know how to put on a mask then the World Health Organisation (WHO) has some pretty good guides, videos etc (they are actually good for something – who knew!).

Secondly, it is easy to explain the different need for a health professional in relation to PPE that a member of the public. Doing some medical procedures can cause a large amount of virus to be spread around in the air, which will never happen normally. Also, medical professionals are dealing repeatedly with people who have a high viral load and can be exposed to large doses. Getting a large dose of a virus gives your own immune system very little time to react and leads to what the medical profession euphemistically call poorer outcomes. This article even contradicts this statement with comments about respirator masks in a later paragraph.

Thirdly, the sneeze evidence is rather mixed and still being investigated. While coughs and sneezes do extend further than many people suggest, the droplet particles that go the furthest are the smallest are destroyed the easiest. No evidence exists to show that this is a transmission route. So, in the absence of evidence you could wear a mask if you wish or stay 2m apart, or whatever. It’s all guesswork & how risk averse you are.

Fourthly, I have seen no evidence that a mask worn out in public will stop you getting the virus. The debate about masks is based on whether wearing one will stop you passing on the virus to someone else by catching the droplets coughed out. There is evidence that it will, but then so will coughing into a tissue.

This update from the science media centre shows their experts view of the latest study:

https://www.sciencemediacentre.org/expert-reaction-to-a-preprint-about-facemask-effectiveness/

They have older responses to previous discussions as well. It’s not definitive, but good to understand the debate.

James Knight

6th April 2020 at 7:14 pm

“Firstly, it fails to take into account that wearing a mask incorrectly can lead to an INCREASED risk of infection.”

It is amazing how they look for every caveat and every excuse in defiance of common sense. Masks may lead to a “false sense of security”. The public won’t use them properly. And so on. They clamour for evidence an proof for masks, but not for shutting down the global economy. Truly perverse.

I don’t recall such arguments about using condoms to protect against HIV. Instead it was universally recognised that condoms were a cheap and effective means to reduce the the risk of infection and prevent a fatal disease.

Lyn Keay

6th April 2020 at 10:03 pm

I told straight people to not bother with condoms. There are better contraceptives & you can’t infect someone with AIDS if you don’t have it. A Lesbian once showed me a dental dam and I laughed so hard I fell off the bed.

I’m not sure who ‘they’ are, but as your replying to my post I’d just like to point out that I haven’t suggested whether or not you should wear a mask. Just that this article is wrong in a number of areas.

I haven’t been following what’s going on in the USA so I’m not sure how wearing a mask became so politicised. Weren’t all the people shouting economy last week saying it the whole social distancing thing was an over-reaction?

Lyn Keay

7th April 2020 at 9:52 pm

OK. Well, I’ve changed my mind. There is possibly more doubt here than I thought. The references made in the article arn’t convincing & have some factual errors in them. But, there is some evidence from the Diamond Princess that something was happening with ventilation & this Nature article is pretty good: https://www.nature.com/articles/d41586-020-00974-w

Ven Oods

6th April 2020 at 5:30 pm

If any mask is better than none, there’s nothing to stop those who wish to wear one from fashioning something from handkerchiefs and the like. A double layer (or treble) should mean there’s no straight path for droplets to reach the airways. As the article notes, wash them regularly.
I’m interested to see how we do against Sweden, where they haven’t gone into lockdown, but are some two weeks behind us in progression of infections.

jmNZ

6th April 2020 at 5:22 pm

Neil Ferguson of Imperial College, London, needs to explain to us why his estimate of the number of deaths from the virus is 131 times the worst-case scenario predicted by WHO data.
It was his advice that panicked parliament into abandoning Johnson’s sensible, pragmatic ‘herd immunity’ strategy, which is working well in Iceland.

Steve Roberts

6th April 2020 at 5:16 pm

Lesh contends that the virus is transmitted through droplets, Fitzpatrick on Spiked today writes the same as do most scientific observers.
If that is the case then it seems pefectly logical – if the purpose is to stop the spread of the droplets throughout the population as the means to defeat it, though that is contested by many scientists – to consider that everyone, presymptomatic, asymptomatic and those infected should wear masks when in public, it would prevent the droplets by a very large degree from settling on surfaces etc.
But there is very considerable oposition to his acceptance of the goverment narrative and some scientists view that “… Covid-19 is threatening because of two essential features: a large amount of time in which people who are asymptomatic or have mild symptoms can give it to others, and a relatively high death rate”
As i understand it Covid is not unique or more particularly threatening than many other viruses including infuenza’s in terms of its transmission by pre or asymptomatic carriers, it has particularly nasty effects is undoubted, but the entire justification for this irrational reaction by governments , though not all, are predicated on the uniqueness of its threat.
Likewise the death rate is simply not known, the amount of deaths are to some extent, but many of those are contested hugely as to whether they are deaths cause by or with covid, this is not pedantry but vital in understanding hwat is happening, Until the number of the population is known or is substantially likely to be known to have been infected at some point the rate cannot be knowm except extremely crudely and hence very unhelpful.
This is just another small example of the destruction of the social fabric that can emanate from accepting the dominant narrative pursued by the state in the UK, are we to all use masks every year in the “flu” season, that is the logic, why not in the past, why now ?

Vadar’s Hate Child

6th April 2020 at 4:35 pm

Can someone explain how an asymptomatic person spreads large quantities of virii (as claimed above). If the virus hasn’t reached high enough levels to cause symptoms, how can it reach high levels in any ejected body fluid? Genuinely interested.

david Oxley

6th April 2020 at 4:30 pm

This opinion piece is highly contentious , the wearing of masks has been discussed often during the Covid crisis as we see many people wearing them in China & as the article states both WHO and the NHS have said that there is limited protection given by wearing a face mask.
The report concluded that wearing a face mask reduced the spread but for those people who were already showing symptoms i.e coughing and sneezing, not for the general use as we suspect people are asymptomatic and can pass the virus, but by touch, so putting a mask on might in fact spread it faster, Covid appears to be spread by touch, so fiddling with a face mask, which is uncomfortable and wet, then touching an escalator would be a great way of spreading the virus & as Michael Fitzpatrick points out on Spiked it is highly unlikely that in your normal day to day life that a droplet would spring from you to another person through the air.
Yes NHS health staff should wear masks, as they are dealing with people at close proximity, who have the symptoms, ie coughing and sneezing in your face. That is why so many poor equiped NHS workers are off work with covid.
Give them the masks, give them the protection but for the general public, it is not necessary and creates the idea that we are the problem, and another barrier when we actually need to be a bit closer, not hiding behind a mask.

Steve Roberts

6th April 2020 at 4:55 pm

Can you advise where it is concluded that presymptomatic and asymptomatic carriers are transmitting the virus by touch. It seems uncontested both groups , many of them children do transmit the disease but i can’t find where it is concluded it is by touch which is your main assertion i think. It could be airborne or droplets.

James Knight

6th April 2020 at 6:44 pm

It is a about proportionality and risk. People are still packed on the London tube and NOBODY is observing 2m social distancing within supermarkets. Modelling shows that if people continually return to a central point like a supermarket the effectiveness of staying at home is hugely reduced. In other words, the economic sacrifice is largely wasted.

Whenever somebody talks tiny droplets of are ejected a considerable distance. This can be seen by Schlieren photography. When you walk past a smoker, you breath their exhaled smoke. Otherwise you don’t notice unless they have bad breath. This is a far more plausible route for infection than a lift button. A mask is a reminder not to touch your face and it is better to touch a mask than your face. It cannot fully eliminate the risk, but it can substantially reduce the viral load people are exposed to. With 80% of people wearing masks the curve could be well and truly steam-rollered.

NHS workers with covid patients do not just wear a mask, they have a full face shield. There is obvious risk of a higher viral load. But for the general public a mask is a cheap and effective mitigation. It only takes one asymptomatic “super-spreader” in the supermarket to make that worth it. Also, they can be a mitigation that could help many people get back to work.

Stef Steer

6th April 2020 at 4:29 pm

Yes I don’t get this, masks are annoying to wear and probably the way I am doing it is not remotely perfect but if everybody did then surely we would reduce infection saving lives and saving trillions probably. At the moment my experience is that maybe 1 or 2 people in a hundred are wearing them hopefully that will increase.

David Jones

6th April 2020 at 4:25 pm

One country in Europe has introduced a requirement to wear face masks during this crisis.That’s the Czech Republic.Their death rate per million population is 10% of the UK’s.7 v. 70.
Of course they did import many millions of them 2-3 weeks ago.

Jonathan Smith

6th April 2020 at 8:39 pm

Yes. The nicked a shed load en route to Italy as well. European brotherhood in action.

Constantine Sotiriou

6th April 2020 at 4:16 pm

‘The science’ just like ‘stay home’ is yet another nauseating Americanism that’s seeped into our lives. After 3 months of being locked away watching The Big Bang theory and Pixar films I expect the majority of the population to emerge with different accents. And fat.

Lyn Keay

6th April 2020 at 6:06 pm

Every time I hear “stay at home” I want to scream. It’s so simplistic. We went from having quite a nuanced set of advice to this! The media was relentless, but the government totally caved. I have a scoring system for the daily press briefing. The ones who modify the mantra are safe but the ones who just repeat the whole 3 phrases get a bad mark. Matt Hancock is currently winning/losing!

Ian Davies

6th April 2020 at 4:13 pm

Simple common sense.

Jerry Sternberg

6th April 2020 at 3:40 pm

It is important to question what expertise the head of research at the ASI has in infectious disease as his linkedin profile would suggest none at all. While we should question all received wisdom, it also is questionable that we should take seriously an opinion piece that passes off reviews of evidence on the basis of a medium.com article or two. Currently the evidence for benefits is marginal, in the case of the most recent systematic review (note it has not yet been peer-reviewed) https://www.medrxiv.org/content/10.1101/2020.04.01.20049528v1.full.pdf

Dominic Straiton

6th April 2020 at 3:35 pm

96% of scientists are always wrong about everything.

Steve Gray

6th April 2020 at 3:21 pm

I would suggest that – at least to date – the face-mask has been worn as a fashion accessory – a bit like back in the 90’s where you’d get Reclaim The Streets -types cycling about wearing an ostentatiously industrial-looking respirator mask.

dysen aristotle

6th April 2020 at 2:42 pm

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ZENOBIA PALMYRA

6th April 2020 at 1:50 pm

More importantly, why are we in such a comprehensive lockdown if the death rates for mid-March were no higher than usual? Why are we locking down the entire population when only certain already vulnerable groups are likely to die from coronavirus?
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/weekending20march2020

ZENOBIA PALMYRA

6th April 2020 at 1:47 pm

So we’re being lied to yet again.

James Conner

6th April 2020 at 1:18 pm

Try buying a face mask in the UK today. Good luck with that.

Bella Donna

6th April 2020 at 3:16 pm

They’re easy to make. See YouTube video. I think we all should have been using them right from the start.

Dominic Straiton

6th April 2020 at 3:36 pm

use half an orange.

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